Background: Parkinson's disease is a chronic condition that affects ~500,000 Americans. Individuals diagnosed with Parkinson's disease require specialized care for their condition from a neurologist. However, 40% of current Medicare beneficiaries with Parkinson's disease either do not have access to or do not utilize a neurologist. Those who do not see a neurologist are ~20% more likely to fracture a hip, to be placed in a skilled nursing home facility, and to die. Simple, inexpensive web-based video conferencing software, akin to Skype, can connect patients in their homes to neurologists at centers of excellence, which are medical institutions supported by the National Parkinson Foundation. In two previous research studies, we demonstrated that providing remote medical care (telemedicine) is feasible, comparable to in-person care, and saves patients and caregivers time and travel. However, the feasibility and value of telemedicine has not yet been demonstrated on a national level.
Objectives: We are conducting a national, randomized study aimed at comparing the effectiveness of using telemedicine to deliver multidisciplinary specialty care to that of a patient’s usual care enhanced with educational materials. In this study, we aim to do the following:
- To demonstrate the feasibility of using telemedicine to deliver care into the homes of individuals with Parkinson's disease who have limited access to care;
- To show that such an approach can improve quality of life;
- To establish that the telemedicine can enhance the quality of care; and
- To demonstrate that this remote approach to care saves time, reduces travel, and decreases caregiver burden.
Methods: The study will be a 12-month, 200-person randomized research study of individuals with Parkinson's disease and limited access to care. Individuals will be randomized to receive care in their homes from specialists, nurses, and other professionals at centers of excellence via web-based video conferencing or to receive their usual care, supplemented by patient-centered educational resources.
Patient Outcomes: Feasibility of conducting remote assessments will be determined by the percentage of patients who complete at least one telemedicine visit. Quality of life for the patient will be measured by the Parkinson Disease Questionnaire 39, and quality of care for the patient will be measured by the Patient Assessment of Care for Chronic Conditions. Time and travel will be assessed using a patient survey, and caregiver burden will be assessed using the Zarit Burden Interview. We aim to provide evidence that will help change the current model of care to one that allows anyone anywhere with a chronic condition to receive the care that he or she needs.
Related PCORI Dissemination and Implementation Award
Mammen JR, Elson MJ, Java JJ, et al., Patient and Physician Perceptions of Virtual Visits for Parkinson's Disease: A Qualitative Study. Telemedicine and e-Health (August 2017).
Dorsey ER, Vlaanderen FP, Engelen LJ, et al., Moving Parkinson care to the home, Movement Disorders (September 2016).
Dorsey ER, Achey MA, Beck CA, et al., National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers. Telemedicine Journal and e-Health (July 2016).
Can Virtual House Calls Provide More Patients with High-Quality Parkinson Disease Care?
This narrative looks at bringing care into the homes of patients with Parkinson's disease using simple videoconferencing software.